Rumination as a transdiagnostic factor in depression and anxiety

The high rate of comorbidity among mental disorders has driven a search for factors associated with the development of multiple types of psychopathology, referred to as transdiagnostic factors. Rumination is involved in the etiology and maintenance of major depression, and recent evidence implicates rumination in the development of anxiety. The extent to which rumination is a transdiagnostic factor that accounts for the co-occurrence of symptoms of depression and anxiety, however, has not previously been examined. We investigated whether rumination explained the concurrent and prospective associations between symptoms of depression and anxiety in two longitudinal studies: one of adolescents (N = 1065) and one of adults (N = 1317). Rumination was a full mediator of the concurrent association between symptoms of depression and anxiety in adolescents (z = 6.7, p < .001) and was a partial mediator of this association in adults (z = 5.6, p < .001). In prospective analyses in the adolescent sample, baseline depressive symptoms predicted increases in anxiety, and rumination fully mediated this association (z = 5.26, p < .001). In adults, baseline depression predicted increases in anxiety and baseline anxiety predicted increases in depression; rumination fully mediated both of these associations (z = 2.35, p = .019 and z = 5.10, p < .001, respectively). These findings highlight the importance of targeting rumination in transdiagnostic treatment approaches for emotional disorders.     

Cognitive reactivity mediates the relationship between neuroticism and depression

Although neuroticism has long been established as an important risk factor for depression, the mechanisms through which this temperamental predisposition translates into the occurrence of symptoms are still relatively unclear. This study investigated cognitive reactivity, i.e. the ease with which particular patterns of negative thinking are reactivated in response to mild low mood, as a potential mediator. Individuals with (N = 98) and without a previous history of depression (N = 83) who had provided neuroticism scores six years previously were assessed for cognitive reactivity and current symptoms of depression using self-report questionnaires. Tendencies to respond to mild low mood with ruminative thinking mediated the relation between neuroticism and current symptoms of depression in both groups. Reactivation of hopelessness and suicidal thinking occurred as an additional mediator only in those with a history of previous depression. The results suggest that neuroticism predisposes individuals to depression by generally increasing the likelihood of ruminative responses to low mood. In those with a history of depression in the past, neuroticism additionally increases risk of recurrence by facilitating reactivation of previously associated patterns such as suicidal thinking and hopelessness. These findings suggest potential targets for interventions to help preventing the occurrence, or recurrence of depression in those who due to their temperamental predisposition are at an increased risk.     

Dispositional mindfulness moderates the relation between neuroticism and depressive symptoms

Negative emotional reactivity as measured by neuroticism has been shown to be an important risk factor for the development of depressive symptoms. This study investigated whether the ability to be mindful can protect against the negative effects of this temperamental vulnerability. An English community sample of N = 144 individuals who had completed a neuroticism questionnaire six years previously were assessed for current depressive symptoms and dispositional levels of mindfulness at points of assessment approximately one year apart. Dispositional mindfulness moderated the relation between neuroticism and current depressive symptoms: Neuroticism was significantly related to depression in those with low to medium levels of dispositional mindfulness but not in those with relatively high levels of mindfulness. Further analyzes focusing on particular mindfulness skills indicated that this effect was carried mostly by the ability to describe inner experience. The results suggest that dispositional mindfulness and particularly the ability to describe inner experience are helpful in dealing with negative emotional reactivity in a way that reduces the likelihood of depressive symptoms to develop.     

Rumination and attention in major depression

Up until recently, it had been assumed that attentional biases for negative information do not exist in depression. However studies using post-conscious exposure durations have produced contradictory results. The limitations of common attentional tasks, suitability of stimulus materials and differences in stimulus duration times may have contributed to these inconsistencies. We aimed to address many of these issues and examine attentional responses in major depression at two post-conscious exposure times. We also investigated possible roles for rumination and distraction in increasing and lessening attentional biases for negative information. We used a fully controlled experimental design to test the effects of both induced and trait rumination and distraction on attention in patients with major depression and healthy controls. Attention was assessed using the dot-probe task. The findings revealed an attentional bias for negative information in depressed patients only at the longer post-conscious exposure duration. Furthermore although this bias was not influenced by either induced or trait distraction, it was related to trait rumination. Overall, the results showed that depression is associated with a strategic attentional bias towards negative information and that this bias is stronger in individuals who habitually ruminate.     

Rumination and social problem-solving in depression

We tested the hypothesis that impaired social problem solving in depression is a consequence of state-oriented rumination, which can be ameliorated by improving awareness of mental processes. 32 currently depressed, 26 recovered depressed, and 26 never depressed participants completed the Means Ends Problem Solving Test while randomly allocated to no questions, state-oriented ruminative questions, (e.g. focusing on why you have a problem) or process-focused questions (e.g. focusing on how you decide to solve a problem). In the no question condition, the currently depressed group was significantly impaired at problem solving compared to the never depressed and recovered depressed groups, which did not differ from each other. As predicted, the process-focused questions significantly improved social problem solving in depressed patients, compared to no questions and state-oriented questions, which did not differ from each other. As predicted, compared to the process-focused questions, the state-oriented questions significantly impaired social problem solving in the recovered depressed group. These results are consistent with recent theories and treatment developments which suggest that increased awareness of mental processes can shift people away from ruminative thinking, thereby, reducing depressive relapse.     

On the links between self-discrepancies, rumination, metacognitions, and symptoms of depression in undergraduates

The present study aimed to test the central components of Papageorgiou and Wells' (2003) non-clinical metacognitive model of rumination and depression that is grounded on the Self-Regulatory Executive Function (S-REF) model of emotional disorders [Wells, A., & Matthews, G. (1994). Attention and emotion: A clinical perspective. Hove, UK: Lawrence Erlbaum.]. A second aim of this study was to extend the non-clinical model with the concept of self-discrepancy in line with the S-REF model. Data of the current study were collected in a large sample of non-clinical Dutch undergraduates (N=196), who completed a battery of questionnaires including measures of rumination, positive and negative metacognitions, depressive symptoms, and self-discrepancy (i.e., actual-ideal, actual-ought, and actual-feared discrepancies). Hypothesized relationships among these variables were tested by means of structural equation modelling. Following some theoretically consistent modifications, the model was an adequate fit to the data. With respect to the second aim of the study, self-discrepancies were directly linked to symptoms of depression as well as indirectly via the cognitive processes involved in the metacognitive model of rumination and depression. Evidence was found for positive beliefs about rumination to partially mediate the relation between self-discrepancy and rumination. Clinical implications of the findings, including implementation of a metacognitive-focused cognitive therapy of depression, and suggestions for future research are discussed.     

Demographic,health-related and psychosocial predictors of changes in depressive symptoms and anxiety in late middle-aged and older persons with fall-related injuries

Research on anxiety and depression after fall-related injuries to the extremities and its pre-fall determinants is scarce. The present study sought to examine change between pre-fall and post-fall anxiety and depression and its (pre-fall) predictors. Data were obtained from 181 Dutch persons, aged 57 and older, who sustained fall-related injuries between 1993 and 1997. Demographic (e.g. socio-economic status), health-related (e.g. number of chronic conditions), and psychosocial (e.g. social support, neuroticism) factors were determined in 1993 (prior to the fall). Depressive symptoms and anxiety were determined prior to the fall, and two, five and twelve months after the fall. Taking into account pre-fall anxiety and depression, pre-fall neuroticism was the most consistent, independent predictor of adverse changes in anxiety and depression. Other factors, including severity of the fall and age were not related to changes in anxiety and depression. Our prospective findings may be interpreted as support for the importance of personality for mental health outcomes in persons who have sustained fall-related injuries.     

Responding to symptoms of depression and anxiety: emotion regulation, neuroticism, and engagement in risky behaviors

The current study examined whether neuroticism, emotional regulation deficits, and/or their interaction predict increased engagement in risky behaviors following increases in symptoms of depression or anxiety over the course of 6 weeks. Results of hierarchical linear modeling analyses indicated that individuals who exhibited high levels of both neuroticism and emotional regulation deficits were more likely than other individuals to report increased engagement in risky behaviors following increases in symptoms of either depression or anxiety. Unexpectedly, individuals who exhibited high levels of neuroticism and adaptive emotion regulation strategies exhibited decreased engagement in risky behaviors following increases in depressive or anxious symptoms.     

Intrusive thoughts mediate the association between neuroticism and cognitive function

Although research has established a negative association between trait neuroticism and cognition, little is known about the mechanisms that underlie this relationship. We examined the tendency to experience intrusive thoughts and negative affect as potential mediators of the relationship between neuroticism and cognitive performance. We hypothesized that the tendency to experience intrusive thoughts reflects ineffective attentional control and would account for the relationship between neuroticism and cognitive performance over and above the mediating effect of negative affect. Three hundred seventeen adults (M_age = 49.43) completed a series of attention-demanding cognitive tasks as well as self-report measures of intrusive thoughts, negative affect, and neuroticism. Intrusive thoughts mediated the association between trait neuroticism and cognitive performance beyond negative affect. These findings are consistent with the hypothesis that the tendency to experience intrusive thoughts is a mechanism through which trait neuroticism influences cognitive performance.     

Group prevention of depression and anxiety symptoms

To prevent depression and anxiety, we delivered a brief, classroom-based cognitive-behavioral workshop along with ongoing Web-based materials and e-mail coaching to college students at risk for depression. At risk was defined as having mild to moderate depressive symptoms on a self-report measure of depression. Two hundred forty students were randomized into either an eight-week workshop that met in groups of 10, once per week for 2 h or into an assessment-only control group. We plan to track participants for 3 years after the workshop and here we report the 6 month preventive effects on depression and anxiety. The workshop group had significantly fewer depressive symptoms and anxiety symptoms than the control group, but there was no significant difference between the conditions on depression or anxiety episodes at 6 month follow up. The workshop group had significantly better well being than the control group, and the workshop group had significantly greater improvement in optimistic explanatory style than the control group. Improved explanatory style was a significant mediator of the prevention effects from pre- to post-workshop for depressive and anxiety symptoms, as well as for improved well being.     

The tripartite model for assessing symptoms of anxiety and depression: psychometrics of the Dutch version of the mood and anxiety symptoms questionnaire

AIM: The tripartite model conceptualizes symptoms of depression and anxiety in three groups: low positive affect and anhedonia, which is specific to depression, somatic arousal, which is unique to anxiety, and nonspecific general distress. The Mood and Anxiety Symptoms Questionnaire (MASQ) was developed to measure these symptom domains. This study reports on the psychometric properties of the Dutch translation of the MASQ. METHOD: The questionnaire was completed by a population-based sample and by patients with anxiety and/or mood disorders. Scores of these respondent groups were compared to assess the discriminant validity of the MASQ and evaluate the appropriateness of the tripartite model. RESULTS: The psychometric properties of the translated MASQ were highly satisfactory. In accordance with the model, we found the MASQ to comprise three main scales, which discriminate well between subgroups of patients with mood and anxiety disorders. DISCUSSION: Overall, like the English version the Dutch translation of the instrument appears to be a reliable and valid measure of symptoms of depression and anxiety, conceptualized as comprising three groups of symptoms. The Dutch MASQ is better able to distinguish unique aspects of mood and anxiety disorders than other self-report instruments.     

Interpersonal cognitive self-focus as a function of neuroticism: Basal tendencies and priming effects

Self-focus is one mechanism that may account for the social-evaluative anxiety of individuals high in neuroticism. The present two studies (total N = 183) sought to cognitively model interpersonal self-focus. The cognitive task was a simple one in which participants simply categorized dyadic interpersonal pronouns, with reaction times as the dependent measure. When others engage us, the pronoun “me” refers to the other and the pronoun “you” refers to the self. Study 1 found a neuroticism by pronoun interaction on categorization time consistent with implicit interpersonal self-focus at high (but not low) levels of neuroticism establishing a basal tendency. Study 2 examined boundary conditions. Individuals high in neuroticism exhibited implicit self-focus particularly to the extent that they had been primed to think of themselves as submissive rather than dominant in their interpersonal interactions. Implications for understanding neuroticism, self-focus, and relationship functioning are discussed.     

The relationship between rumination, avoidance and depression in a non-clinical sample

Recent commentaries have proposed conceptualizations of rumination in terms of both cognitive and behavioral avoidance. This study examined the relationship between rumination, avoidance and depression using a newly developed self-report measure of avoidance in depression, the Cognitive-Behavioral Avoidance Scale (CBAS) [Ottenbreit, N.D., & Dobson, K.S. (2004). Avoidance and depression: The construction of the cognitive-behavioral avoidance scale. Behaviour Research and Therapy, 42, 293-313]. A non-clinical sample (N=104) of undergraduate students completed self-report measures of depression, anxiety, rumination and avoidance. Rumination, avoidance and depression were all significantly correlated. Rumination and behavioral avoidance remained intercorrelated when anxiety was controlled, confirming an association that is independent of anxiety. By contrast, the relationship between cognitive avoidance and rumination disappeared when anxiety was partialled out. Notably, avoidance predicted unique variance in depression scores, over and above anxiety and rumination. Consistent with the proposal of Ottenbreit and Dobson [Avoidance and depression: The construction of the cognitive-behavioral avoidance scale. Behaviour Research and Therapy, 42, 293-313], our findings support the value of clinicians and psychopathologists giving consideration to avoidance in their conceptualization of depression.     

Worry and rumination: differential associations with anxious and depressive symptoms and coping behavior

Worry and rumination are closely allied cognitive processes that impact on the experience of anxious and depressive symptoms. Using a prospective design, this study examined overlapping and distinct features of worry and rumination in relation to symptoms and coping behavior in a nonclinical sample of Singaporean college students. Worry and rumination were highly correlated, but they retained distinct components that predicted anxious and depressive symptoms differentially within and across time. Specifically, worry was uniquely associated with anxious and depressive symptoms whereas rumination was uniquely related to depression. In comparison to rumination, worry emerged as the dominant cognitive vulnerability factor that predicted increments in symptoms over time. With regards to coping behavior, low perceived coping effectiveness partially mediated the relation between worry and increases in anxiety and depression. Conversely, rumination uniquely predicted higher disengagement from problems, which resulted in further exacerbation of depressive mood. These results demonstrated not only the distinct features of worry and rumination on coping behavior, but also the different coping pathways by which they differentially impact on subsequent symptoms.     

Sensory processing sensitivity and its relation to parental bonding, anxiety, and depression

Sensory processing sensitivity is a recently proposed construct referring to a tendency to process a variety of information more strongly and deeply than others. Although some research has found links between sensory processing sensitivity and psychological difficulties, highly sensitive people may not necessarily be predisposed to negative affect, but may be more sensitive to poor parenting. Two hundred thirteen college students were given a measure of sensory processing sensitivity (the HSPS), the parental bonding scale (measuring parental care and over-protection), the trait anxiety scale, and the Beck depression inventory. Sensory processing sensitivity predicted both anxiety and depression above and beyond parental factors, indicating that it may be an independent risk factor. An interaction was found between sensory processing sensitivity and parental care when measuring depression. Highly sensitive people may be particularly sensitive to uncaring parents. Results indicate that sensory processing sensitivity may be a temperamental disposition that interacts meaningfully with environmental factors.     

The relationship between anxiety sensitivity and latent symptoms of emotional problems: A structural equation modeling approach

A large body of research suggests that common and specific psychopathology dimensions underlie the symptoms that occur within mood and anxiety disorders. As of yet, it is unclear precisely how the facets of Anxiety Sensitivity (AS), or fear of the symptoms of fear and anxiety, relate to these latent factors. Using data from 606 adolescents participating in the baseline phase of a longitudinal study on risk factors for emotional disorders, we modeled the facets of AS as measured by the Anxiety Sensitivity Index-Expanded Form (ASI-X) and related these facets to a hierarchical model of latent symptoms of psychological distress. Results suggest that one facet of AS is associated with a broad General Distress factor underlying symptoms of most emotional disorders while others relate to intermediate-level and conceptually-meaningful narrow factors representing aspects of psychological distress specific to particular emotional disorders.     

Implicit depression and hopelessness in remitted depressed individuals

Cognitive theories of depression posit that automatically activated cognitive schemas, including negative thoughts about the self and the future, predispose individuals to develop depressive disorders. However, prior research has largely examined these constructs using explicit tests in currently depressed individuals. Using the Implicit Association Test (IAT), the present study examined automatic associations between the self and mood state ("depression IAT") and between the future and mood state ("hopelessness IAT") before and after a negative mood induction in 19 remitted depressed individuals and 23 healthy controls. In the depression IAT, remitted depressed participants exhibited an overall lower tendency to associate themselves with happiness relative to the healthy controls before the mood induction. Control, but not remitted depressed, participants' automatic associations between the self and happiness diminished following the mood induction. Contrary to our hypotheses, no significant findings emerged when considering the hopelessness IAT. Consistent with prior studies, no significant correlations emerged between implicit and explicit biases, suggesting that these measures probe different processes. Results extend prior IAT research by documenting the presence of a reduced tendency to associate the self with happiness in a sample at increased risk for depression.     

Exploring the relation between visual mental imagery and affect in the daily life of previously depressed and never depressed individuals

Previously depressed individuals experience disturbances in affect. Affective disturbances may be related to visual mental imagery, given that imagery-based processing of emotional stimuli causes stronger affective responses than verbal processing in experimental laboratory studies. However, the role of imagery-based processing in everyday life is unknown. This study assessed mental imagery in the daily life of previously and never depressed individuals. Higher levels of visual mental imagery was hypothesised to be associated with more affective reactivity to both negatively and positively valenced mental representations.

This study was the first to explore mental imagery in daily life using experience sampling methodology. Previously depressed (n?=?10) and matched never depressed (n?=?11) individuals participated in this study. Momentary affect and imagery-based processing were assessed using the “Imagine your mood” smartphone application. Participants recorded on average 136 momentary reports over a period of 8 weeks.

The expected association between visual mental imagery and affective reactivity was not found. Unexpectedly, in both previously and never depressed individuals, higher levels of imagery-based processing of mental representations in daily life were significantly associated with better momentary mood and more positive affect, regardless of valence.

The causality of effects remains to be examined in future studies.     

Rumination: Bridging a gap between forgivingness, vengefulness, and psychological health

It was argued in the present investigation that dispositional forgiveness and vengeance would be differentially related to components of rumination, and thus the mediating role of rumination in their relations with psychological health would also vary. Male and female undergraduates (N = 183) completed questionnaires assessing predispositions toward forgiveness, vengefulness, rumination, depressive affect, and life satisfaction. Regression analyses revealed that higher forgiveness and lower vengefulness were associated with greater psychological health (lower depressive affect; higher life satisfaction). Moreover, the relations between forgiveness (but not vengefulness) and psychological health were partially mediated by the decreased propensity of high forgivers to endorse ruminative brooding. These findings suggest that, although forgiveness and vengeance may be related, their impacts on psychological health reflect distinct ruminative tendencies.     

Humor styles impact the relationship between symptoms of social anxiety and depression

Recent research suggests that examining humor styles may contribute to our understanding of clinical problems, such as risk and resiliency. The goal of the current study was to examine whether humor styles moderate the association between social anxiety and depressive symptoms in an unselected sample. Three-hundred and six participants (66% female) at a large Southern US university completed self-report measures of humor styles and symptoms of social anxiety and depression. Regression analyses suggested that affiliative and self-defeating humor styles individually moderated the relationship between social anxiety and depressive symptoms. Clinical implications regarding the monitoring of humor use as a means of understanding the maintenance of depressive symptoms among socially anxious individuals are discussed.